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Organization
RETIRED
Active
Organization
RETIRED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERB BASTOW M.D. (UROLOGIST)
(573) 696-2391
Entity
Organization
Contact information
Practice address
13714 N SPORTSMANS DR, HALLSVILLE, MO 65255-9330
(573) 696-2391
Mailing address
13714 N SPORTSMANS DR, HALLSVILLE, MO 65255-9330
(573) 696-2391
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
R5108
MO
Other
Enumeration date
07/06/2014
Last updated
07/06/2014
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